ebook THE GUILFORD PRESS TREATING SOMATIC SYMPTOMS IN CHILDREN AND ADOLESCENTS The Guilford Child and Adolescent Practitioner Series Editors: John Piacentini and John T. Walkup This series offers effective, innovative intervention strategies for today’s child and adoles- cent practitioners. Focusing on persistent clinical challenges that cut across diagnoses and often come up in practice, books in the series present evidence-based tools for conceptu- alizing and addressing clients’ individualized needs. These concise volumes provide what is missing from many evaluation and treatment manuals: the nuts-and-bolts techniques required for everyday clinical work. Each accessible guidebook includes a treasure trove of suggested interventions, complete with case examples, practical tips, sample dialogues, and practitioner-friendly resources, such as reproducible handouts and forms. Teen Suicide Risk: A Practitioner Guide to Screening, Assessment, and Management Cheryl A. King, Cynthia Ewell Foster, and Kelly M. Rogalski Psychological Interventions for Children with Sensory Dysregulation Ruth Goldfinger Golomb and Suzanne Mouton-Odum Treating Somatic Symptoms in Children and Adolescents Sara E. Williams and Nicole E. Zahka Treating Somatic Symptoms in Children and Adolescents SARA E. WILLIAMS NICOLE E. ZAHKA Series Editors’ Note by John Piacentini and John T. Walkup The Guilford Press New York London Copyright © 2017 The Guilford Press A Division of Guilford Publications, Inc. 370 Seventh Avenue, Suite 1200, New York, NY 10001 www.guilford.com All rights reserved Except as indicated, no part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 9 8 7 6 5 4 3 2 1 LIMITED DUPLICATION LICENSE These materials are intended for use only by qualified mental health professionals. The publisher grants to individual purchasers of this book nonassignable permission to reproduce all materi- als for which permission is specifically granted in a footnote. This license is limited to you, the individual purchaser, for personal use or use with individual clients. This license does not grant the right to reproduce these materials for resale, redistribution, electronic display, or any other purposes (including but not limited to books, pamphlets, articles, video- or audiotapes, blogs, file-sharing sites, Internet or intranet sites, and hand- outs or slides for lectures, workshops, or webinars, whether or not a fee is charged). Permission to reproduce these materials for these and any other purposes must be obtained in writing from the Permissions Department of Guilford Publications. The authors have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards of practice that are accepted at the time of publication. However, in view of the possibility of human error or changes in behavioral, mental health, or medical sciences, neither the authors, nor the editor and publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or the results obtained from the use of such information. Readers are encouraged to confirm the information contained in this book with other sources. Library of Congress Cataloging-in-Publication Data Names: Williams, Sara Elizabeth, 1976– author. | Zahka, Nicole E., author. Title: Treating somatic symptoms in children and adolescents / Sara E. Williams and Nicole E. Zahka. Other titles: The Guilford child and adolescent practitioner series. Description: New York, NY : The Guilford Press, 2017. | Series: The Guilford child and adolescent practitioner series | Includes bibliographical references and index. Identifiers: LCCN 2016049135 | ISBN 9781462529520 (hardcover : alk. paper) Subjects: | MESH: Somatoform Disorders—therapy | Cognitive Therapy | Signs and Symptoms | Child | Adolescent Classification: LCC RC552.S66 | NLM WM 170 | DDC 616.85/24—dc23 LC record available at https://lccn.loc.gov/2016049135 Illustrations by Scott Stoll. About the Authors Sara E. Williams, PhD, is a pediatric psychologist at Cincinnati Children’s Hospital Medical Center, where she is Clinical Director of the Functional Independence Resto- ration (FIRST) program for inpatient pediatric chronic pain rehabilitation. She is also Associate Professor of Pediatrics at the University of Cincinnati College of Medicine. Dr. Williams specializes in assessing, treating, and researching pediatric chronic pain conditions. Nicole E. Zahka, PhD, is a pediatric psychologist at Cincinnati Children’s Hospital Medical Center. Her practice includes children and adolescents with chronic medi- cal conditions and anxiety disorders, with a specialty in assessment and treatment of conversion and functional movement disorders, as well as syncope and gastrointesti- nal disorders. v Series Editors’ Note I n The Guilford Child and Adolescent Practitioner Series, our goal is to provide practitioners with a library of relatively short, practical, theory-driven books focused on common clinical problems and key intervention techniques. The books in this series differ from existing treatment manuals in that they do not focus on specific dis- orders such as obsessive–compulsive disorder (OCD), major depression, or attention- deficit/hyperactivity disorder (ADHD), but rather on clinical issues that cut across specific disorders or fall between the so-called diagnostic “cracks.” These clinical challenges—including the treatment of sleep and somatic problems, sensory intoler- ance, unwanted habits, and adolescent noncompliance, among others—are common in children and adolescents in therapy and can confound clinicians, many of whom have not encountered them in training or in their clinical work. By offering clearly and coherently organized titles that provide relentlessly practi- cal, step-by-step guidance, we hope to help busy practitioners select and implement the assessment and intervention strategies best suited to their needs. Common to each of these titles is an emphasis on the functional understanding of the antecedents (e.g., triggers) and consequent factors that serve to elicit and maintain the present- ing problem. This theoretical framework provides a clear conceptual link between the target psychopathology and specific assessment and treatment techniques. Ample case examples illustrate case conceptualization and treatment selection and imple- mentation. The technical aspects of the intervention are explained through clinical illustrations, sample dialogue, and handouts, forms, and other practitioner-friendly material. Each book in the series provides relevant information about the topic problem, including a description of how the behavior begins and is maintained, and how the problem may manifest and change over development and across different settings and contexts. The theoretical models underlying the problem behavior and interven- tion strategies are presented along with existing research support for these strategies. Guidelines for recognizing and addressing challenges that may arise during treat- ment are also detailed. Finally, given the common occurrence of the target behaviors vii viii Series Editors’ Note covered in this series with other clinical problems, strategies for integrating the selected treatment into a more comprehensive treatment plan are provided. In this book, Sara Williams and Nicole Zahka describe the evaluation and treat- ment of children and adolescents with somatic symptoms, a challenging situation in which kids experience real, physical symptoms without known medical cause or easy explanation. As defined in this volume, somatic symptoms lasting for several months or more and leading to significant impairment are common in youth with medical and psychological disorders and can be highly perplexing, not only for the children and their families, but also for the medical and therapeutic communities with whom these individuals come into contact. As a result, affected youth can endure numerous costly and invasive medical procedures that fail to yield causal information or relief. Not surprisingly, high levels of frustration, distress, and disability are common. Drs. Williams and Zahka, both expert pediatric psychologists with considerable experience working with children and adolescents suffering from somatic symptoms and with their families, present a comprehensive biopsychosocial model for evaluat- ing and treating this often vexing problem. They expertly describe how the therapist can bridge the gap between the medical and psychological aspects of the child’s expe- rience and teach the child and family the connection between physical symptoms and underlying psychosocial stressors. Once the child and family have developed a reasonable understanding of these connections, cognitive-behavioral therapy is used to teach children how to respond to their stressors in a more adaptive way. Of critical importance, the authors also provide clear guidelines for therapists to use in navigat- ing the larger treatment context, including step-by-step instruction in effective strate- gies for collaborating with other family members, schools, and health care profes- sionals necessary to ensure generalizable and durable treatment outcomes. Highly detailed case material and sample treatment plans provide therapists with the hands-on clinical material that is rarely available in treatment manuals. If you need expert guidance in dealing with puzzling presentations of complex symptom patterns, this is the right book for you. We are very familiar with the work of these authors and know their treatment approach to be very helpful in improving the lives of children and adolescents with somatic symptoms and those of their families. We trust the highly valuable information in this book will be extremely useful to you in your practice. John Piacentini, PhD John t. WalkuP, MD
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